The edition · Internal Medicine
Sizing the risk of anti-amyloid therapy, two 2026 guidelines, and the follow-up problem
A meta-analysis quantifies the imaging risk of anti-amyloid antibodies, a systematic review finds little reliably improves follow-up after an alcohol-related admission, and the 2026 tobacco and KDIGO anaemia guidelines set clearer defaults.
The edition in brief
Five findings for the internal medicine desk, for physicians carrying multisystem patients. A meta-analysis of 21 phase 3 trials and 12,610 patients put the incidence of amyloid-related imaging abnormalities on anti-amyloid monoclonal antibodies at 5.4% for oedema-type and 10.3% for haemorrhage-type, mostly asymptomatic, with ApoE4 homozygotes at sharply higher risk. A systematic review of interventions to improve outpatient follow-up after an alcohol-use-disorder admission found only a third reliably improved linkage, with low certainty, though the components that worked combined behavioural support, care coordination and medication. The 2026 VA/DoD tobacco guideline strengthens familiar defaults: motivational interviewing, varenicline over other single agents, and combination nicotine replacement over monotherapy, and offers pharmacotherapy even to those not ready to quit. A pearl covers medication reconciliation and deprescribing at discharge. The practice-changer is the KDIGO 2026 anaemia-in-CKD guideline, which keeps erythropoiesis-stimulating agents as first-line over the newer oral HIF-prolyl-hydroxylase inhibitors, prefers intravenous iron in haemodialysis, asks clinicians to correct other causes of anaemia first, and caps the maintenance haemoglobin target below 11.5 g/dL.
How often anti-amyloid antibodies cause imaging abnormalities
Before anti-amyloid therapy, factor in ApoE4 genotype and baseline MRI, and review anticoagulation and blood pressure, since imaging abnormalities are common though usually silent.
After an alcohol-related admission, little reliably improves follow-up
Do not discharge an alcohol-use-disorder admission on a referral alone; bundle behavioural support, care coordination and in-hospital medication, while recognising the evidence is weak.
The 2026 tobacco-treatment guideline sharpens the defaults
Reach for varenicline first and combine nicotine replacement rather than a patch alone, and offer pharmacotherapy to smokers even when they are not yet ready to quit.
Medication reconciliation and deprescribing at discharge
Treat every discharge as a deprescribing opportunity: reconcile both what was added and omitted, and write the reasoning for the patient and general practitioner.
KDIGO 2026: ESAs stay first-line for anaemia in CKD
For anaemia in CKD, keep erythropoiesis-stimulating agents as first-line over oral HIF-PHIs, correct other causes first, and hold the maintenance haemoglobin below 11.5 g/dL.
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